A simple method for joining one hollow organ end-to-side to another hollow organ, without interrupting fluid follow in the efferent organ has long been desired in the medical practice, particularly in the field of cardiovascular surgery. Conventional methods for joining (anastomosing) two blood vessels in an end-to-side configuration invariably necessitates halting blood flow in the efferent or outflow blood vessel, jepoardising the viability of tissues perfused by the outflow blood vessel. To overcome this drawback, a surgical technique has been described in medical literature that involves the stitching of a metal ring to the outflow vessel (Tulleken CAF, et. al. Acta Neurochir 1995; 134:66–70), and a tubular prosthesis to the inflow or afferent limb of the anastomosis. The later is stitched to the metal ring, and luminal continuity established with the help of optical energy transmitted by a catheter passed through the tubular prosthesis. The complexity of the procedure has hindered its adoption by surgeons.
Hence the use of a biocompatible adhesive instead of stitches has been advocated and devices exploiting the idea have been disclosed in PCT/NO99/00093.
The present invention extends this concept further by providing the means for implanting a prosthesis on a blood vessel without the need for manipulation of the blood vessel, making performance of remote-controlled, robot-assisted vascular anastomosis a clinically realistic proposition.
The coupling device comprises:                a double-walled, substantially thimble-formed, ring shaped member consisting of at least one ring section, wherein each ring section comprises at least one radial partition walls defining at least two chambers, and a common upper chamber limited by a section roof, wherein the chambers are adapted for aposing to the anastomosis prosthesis and fastening to said prosthesis by means of a suction pressure, wherein the common upper chamber provides a channel in fluid connection with the chambers,        a tubing connection assembly in fluid connection with said channel for transmitting a suction pressure from a suction apparatus to the chambers, and        a fixation mechanism for fastening the ring shaped member to an anastomosis apparatus. The coupling device is thus meant for attachment to the prosthesis by suction, where the floor of the at least one section is apposed to the prosthesis.        
There are several alternative ways of fastening the coupling device to the anastomosis apparatus, but all embodiments have the common feature that they permit easy, secure and precise fastening of these parts together.
In one embodiment of the invention, the coupling device is non-detachably attached to the deployment apparatus.
Back to the coupling device, in a first embodiment of the invention the coupling device comprises a fixation mechanism with:                an attachment plate with a rectangular projection or offset block, the attachment plate and the offset block being perforated, and        a threaded fixation pin through the attachment plate and the offset block, where the pin is provided on or in the vicinity of one end with a nut and on or in the vicinity of the other end with a fixation plate,        where the offset block and the fixation plate are meant to be tightened against an outer and an inner surface respectively in a deployment tube in the apparatus by means of the pin.        
In a second embodiment of the invention the fixation mechanism comprises:                an attachment plate with a rectangular projection or offset block, and        a fixation pin extending between the offset block and a fixation plate,        where the offset block and the fixation plate are meant to be arranged against an outer and an inner surface respectively in a deployment tube in the apparatus.        
In a third embodiment the fixation mechanism comprises:                a torsion spring, where one limb of the torsion spring is attached to the fixation plate and the other limb is accommodated in a groove in the offset block,        where the torsion spring is meant for pushing the fixation pin into a fixation slot in a deployment tube in the fixation apparatus.        
In a fourth embodiment the fixation mechanism comprises a bent resilient wire in stead of a torsion spring, where one limb of the wire is attached to the fixation plate and the other limb is accommodated in a groove in the offset block, where the resilient wire is meant for pushing the fixation pin into a fixation slot in a deployment tube in the fixation apparatus.
In a fifth embodiment the fixation mechanism comprises:                an attachment plate with a rectangular projection or offset block, and        a polymer hook or loop patch bonded to the offset block,        where the hook patch is meant for fastening the offset block to a corresponding polymer loop or hook patch on a deployment tube in the anastomosis apparatus.        
In a sixth embodiment the fixation mechanism comprises:                an attachment plate with a rectangular projection or offset block, and        a flat magnet bonded to the offset block,        where the flat magnet is meant for fastening the offset block to at least one corresponding ferromagnetic patch on a deployment tube in the anastomosis apparatus.        
In a preferred embodiment of the invention the chambers are provided with a mesh on the surface adapted for aposing to the anastomosis prosthesis.
The deployment apparatus comprises:                a targeting tube,        a deployment tube provided with a fastening device for cooperation with a fixation mechanism in the prosthesis coupling device, for fastening said prosthesis coupling device to said deployment tube,        a flow control valve for controlling fluid flow in and out of the apparatus, wherein the inlet of the valve is adapted for connection to a suction apparatus, and a first outlet of the valve is coupled to a fluid connecting device adapted for connection to a corresponding tubing connection assembly in the anastomosis coupling device,        a flow control lever for controlling flow through said valve, and        a trigger for displacing the deployment tube in relation to the body of the apparatus,        a device for connecting the apparatus to a suction apparatus.        
As one can see, the apparatus according to the invention has a targeting tube that permits a precise localisation of the apparatus at the anastomosis site, a deployment tube for receiving the coupling device and thus the prosthesis, and two triggering/control devices for controlling on one side suction pressure to be exerted by the coupling device against the anastomosis prosthesis and on the other side the movement of the prosthesis towards the anastomosis site. In one embodiment the targeting tube is adapted for applying suction to the organ to be anastomosed, thereby securing a stationary location of the apparatus. In another embodiment the apparatus is adapted for apposing the anastomosis prosthesis to the target organ with positive pressure.
In a first embodiment of the apparatus, adapted for use together with the first to fourth embodiments of the coupling device, the fastening device consists of at least one fixation slot extending from the edge of the deployment tube.
In a second embodiment of the apparatus, specially adapted for use together with the second embodiment of the coupling device each fixation slot comprises a long limb, a fixation fluke, a transverse limb and a short limb, where the fixation fluke is meant for securing a fixation pin in a fixation mechanism in the prosthesis coupling device into the short limb of the fixation slot.
In a third embodiment of the apparatus, specially adapted for use together with the third embodiment of the coupling device each fixation slot comprises a long limb, a transverse limb and a short limb, where the short limb is meant for receiving a fixation pin in a fixation mechanism in the prosthesis coupling device.
In a fourth embodiment of the apparatus, adapted for use together with the fifth embodiment of the coupling device the fastening device consists of at least one loop or hook polymer patch arranged on the deployment tube for fastening to a corresponding hook or loop patch in a fixation mechanism in the prosthesis coupling device.
In a fifth embodiment of the apparatus, adapted for use together with the sixth embodiment of the coupling device the fastening device consists of at least one ferromagnetic patch arranged on the deployment tube for fastening to a corresponding magnet in a fixation mechanism in the prosthesis coupling device.
In a preferred embodiment, the apparatus comprises an inlet for introduction of imaging or flow measuring devices.
As stated before, in another preferred embodiment of the invention the second outlet of the flow control valve is coupled to the inside of the targeting tube for transmitting a suction pressure to said targeting tube.
In another embodiment of the invention the coupling device is non-detachably attached to the deployment apparatus.
The implantable anastomosis prosthesis comprises a first tubular member to be placed around a first organ, and a flat sheet or attachment member to be placed on a second organ, wherein the luminal or inner surface of the tubular member is continuous with the surface of the flat member facing the second organ.
Use of the apparatus according to the invention will now be described briefly:                1) The coupling device is attached to the deployment tube,        2) the targeting tube is introduced into the side-arm of the anastomosis prosthesis,        3) the prosthesis is slid up the targeting tube till the prosthesis flat member abuts the coupling device,        4) the coupling device is fastened to the prosthesis,        5) the apparatus is introduced into the body and the tip of the targeting tube is placed at the chosen side for anastomosis,        6) the triggering device is pressed activating the actuator, and the deployment tube is longitudinally displaced along the targeting tube towards the organ, thereby delivering the mounted anastomosis prosthesis to the organ,        7) the anastomosis prosthesis is pressed against the organ,        8) the coupling device is detached from the anastomosis prosthesis.        
The implantable anastomosis prosthesis is secured to the coupling device by establishing suction pressure between the coupling device and the prosthesis. When the prosthesis is in place at the desired site in the body, suction pressure is eliminated and the prosthesis is no longer fastened to the coupling device. In a further preferred embodiment of the invention the pressure is increased after the prosthesis is in place thereby apposing the flat member of the prosthesis to tissue at the desired site.
The apparatus according to the invention combines pure a mechanical part for delivering the prosthesis to the anastomosis site and a fluid driven part for fastening the coupling device to the prosthesis, optionally fastening the targeting tube to the organ and in a preferred embodiment pressing the prosthesis against the organ.